Screening for cervical cancer starts at a young age- 21 for most women- which often occurs before childbearing and pregnancy. When we screen women for cervical dysplasia and subsequently treat it, it's easy to get caught up in the primary objective (prevent or stop cancer) and to forget about considerations for long term health, such as the implications for future pregnancy. Since the cervix plays a key role in pregnancy (keeping the fetus safely in the uterus!), it follows that treating cervical dysplasia could affect pregnancy in the future. Read on to learn four ways treatment of cervical dysplasia can affect pregnancy outcomes.
Infection with HPV is relatively common, but is associated with development of cervical cancer. In 1 year, about 66% of HPV infections resolve spontaneously. In 2 years, 90% of cases resolve. Even low-grade dysplasia- CIN 1- can resolve on its own. However, higher grade neoplasia- CIN 2 and 3- are less likely to resolve and more likely to progress into invasive cervical cancer. 5% of CIN 2 progresses to invasive cancer, and up to 40% of CIN 3 progresses to cervical cancer. Therefore, treatment of neoplasia with either excision or ablation are key to preventing cervical cancer. However, treating cervical dysplasia causes changes to the cervix that are theorized to affect pregnancy later on. For instance, treatments may decrease cervical mucus, result in scarring, or cause collagen breakdown and loss of cervical bulk.
1. Miscarriage: When comparing women treated for cervical dysplasia and those who have never received such treatment, treated women have a higher rate of second-trimester miscarriage. First trimester miscarriage rates are no different between the two groups.
2. PPROM: Women who have had a LEEP procedure in the past have twice the risk of preterm premature rupture of membranes. Cold Knife Cone (CKC) is associated with an even higher risk of PPROM.
3. Preterm Birth: Excisional procedures including LEEP and CKC are both associated with a higher risk of preterm birth. For women who have received a CKC procedure, their relative risk of severe preterm delivery is 2.8X and of extreme preterm delivery is 5.3X. LEEP has slightly lower rates, and ablation has the lowest rates of the three treatments.
4. Ectopic Pregnancy: Some evidence points to higher rates of ectopic pregnancy after treatment for cervical dysplasia.
Some doctors recommend waiting at least 1 year after treatment of high grade dysplasia before attempting pregnancy since pregnancy complications may be increased at less than 1 year of healing time. We want to hear from you! Do you take future pregnancy risks into account when treating cervical dysplasia? How?